单纯斜外侧腰椎间融合术后融合器下沉的危险因素及其对临床疗效的影响

Risk factors and influence on clinical efficacy of cage subsidence after stand-alone oblique lateral interbody fusion in lumbar spine

目的:探讨单纯斜外侧腰椎间融合术(stand-alone-oblique lateral interbody fusion,SA-OLIF)治疗退变性腰椎疾病术后融合器下沉的危险因素及其对临床疗效的影响。方法:回顾性分析2018年1月~2021年10月在我院行SA-OLIF手术治疗的89例腰椎退变性疾病患者的临床资料。收集患者的一般资料[年龄、性别、体重指数(body mass index,BMI)、吸烟状况、激素使用情况、疾病类型以及是否合并骨质疏松]和手术相关资料[手术时间、术中出血量、手术节段、融合节段数、融合器高度],在腰椎正侧位及脊柱全长X线片上测量患者术前、术后1周手术融合节段椎间隙高度(disc height,DH)、腰椎前凸角(lumbar lordosis,LL),计算矫正值。术前和术后3个月、6个月、1年时进行Oswestry功能障碍指数(Oswestry disability index,ODI)评定及腰腿痛视觉模拟评分(visual analogue scale,VAS)。根据患者术后1年手术节段椎间隙高度丢失值将患者分为两组:DH丢失值≥2mm为下沉组(17例);DH丢失值<2mm为未下沉组(72例)。对可能影响融合器下沉的因素进行单因素统计分析及多因素logistic回归分析,确定SA-OLIF术后患者融合器下沉的危险因素及对临床疗效的影响。结果:两组患者的年龄、合并骨质疏松、融合器高度、术后1周DH、矫正DH等资料有统计学差异(P<0.05)。Logistic回归分析结果显示年龄(OR=2.889,95%CI:1.807,4.979)、合并骨质疏松(OR=3.753,95%CI:1.926,15.210)、术后1周DH(OR=2.777,95%CI:1.155,3.903)、矫正DH(OR=1.965,95%CI:1.523,4.334)为腰椎退行性变行SA-OLIF手术后融合器下沉的独立危险因素。两组间术前及术后3个月、6个月及1年时VAS评分及ODI的差异均无统计学意义(P>0.05)。结论:年龄大、骨质疏松严重、术中矫正DH大会增加融合器下沉风险;融合器下沉对SA-OLIF术后1年内的临床疗效无明显影响。

Objectives:To explore the risk factors of cage subsidence after stand-alone-oblique lateral interbody fusion(SA-OLIF)in the treatment of lumbar degenerative diseases(LDD)and the influence of cage subsidence on clinical efficacy.Methods:The clinical data of 89 LDD patients who underwent SA-OLIF surgery in our hospital from January 2018 to October 2021 were analyzed retrospectively.According to the loss value of disc height(DH)one year after operation,the patients were divided into two groups:cage subsidence group(≥2mm,n=17)and cage non-subsidence group(<2mm,n=72).The general data of the patients including age,sex,body mass index(BMI),smoking status,hormone use,disease type,and osteoporosis,and operation related data such as operative duration,intraoperative blood loss,operation segment,number of fusion segment,and cage height were collected and compared between the two groups.The DH of fusion segment and lumbar lordosis(LL)were measured on anteroposterior and lateral lumbar spine and whole spine X-ray films before operation and at one week after operation to calculate correction values.The clinical efficacy was e valuated with Oswestry disability index(ODI)and visual analogue scale(VAS)of low back and leg pain before operation and at 3 and 6 months,and 1 year after operation.Univariate analysis and multi-factor logistic regression analysis were used to analyze and determine the risk factors of cage subsidence and influence of cage subsidence on clinical effects.Results:Univariate analysis showed that there were significant differences in age,osteoporosis,cage height,postoperative 1 week DH and surgically corrected DH between the two groups(P<0.05).Logistic regression analysis showed age(OR=2.889,95%CI:1.807,4.979)and osteoporosis(OR=3.753,95%CI:1.926,15.210),postoperative DH(OR=2.777,95%CI:1.155,3.903)and intraoperative corrected DH(OR=1.965,95%CI:1.523,4.334)were the independent risk factors for cage subsidence after SA-OLIF surgery for LDD.There was no significant difference in VAS score and ODI between cage subsidence group and non-cage subsidence group before operation,and at 3 months,6 months and one year after operation(P>0.05).Conclusions:The older the age,the more serious the osteoporosis and the higher the corrected DH during operation can increase the risk of cage subsidence.Cage subsidence has no significant effect on the clinical effect within 1 year after SA-OLIF.